Executive Page

As every year, spring time is high season for preparing for the annual congress - this year the 4th congress of the European Academy of Neurology in Lisbon. It is the annual main event of our Society and we expect around 6000 participants in this special and historically attractive Portuguese capital. The congress has continuously adapted its profile and one of the main goals of our Society is to continuously develop new formats which satisfy the requests of modern neurology and its drivers, the European Neurologists. Our program committee under the leadership of Prof. Boon has excellently realized this request with many new innovations.

Education is one of the key elements of the activities of the European Academy of Neurology. While the congress is well known to most of our members and European Neurologists the activities outside the congress are much less known. EAN has a special committee working on education[1] with Prof. Hannah Cock as the chair and the teaching course subcommittee under the leadership of Prof. Claudia Sommer. They are charged to develop an educational program including education for neurologists in training and advanced courses with the emphasis on training for the general neurologist. While the field of Neurology is getting increasingly broader it is of paramount importance to set a common ground for all neurologists which our education committee has carefully developed. For the congress educational programme, a five-year curriculum of the educational content covering all relevant topics has been developed over the past 3 years and parts of this plan are also applied to the educational activities outside the congress.

Neurological diseases have a very different frequency. Neurological practice and brain research need to have this in mind. The global burden of disease study has shown that neurologic diseases are the leading cause group of disability-adjusted life years (DALYs) of all medical disease groups in 2015 with 10.2% of global DALYs. Table 1 shows the age-standardized rates of DALYs, deaths and the prevalence of the different neurologic diseases.1 In this schematic rare neurological diseases are mostly covered within the category ‘other neurological diseases’. The prevalence cannot be estimated based on the available data. However, the number of existing rare neurological diseases is very large. The current website of the NIH lists 1244 neurologic rare diseases which is the largest number among all rare disease groups and covers approximately 60% of rare diseases.2 These more than 1200 diseases produce more than 0.9% of the neurological DALYs world-wide which seems at first glance to be relatively small.

The past year has been a good year for neurology. With the major progress for neurological treatments and the aging of the population, neurology is becoming one of the key disciplines of medicine. Its organized bodies like the World Federation of Neurology, the regional societies in America, Asia and Europe as well as the specialty societies for stroke, movement disorders, dementia, multiple sclerosis and many other diseases are becoming the key drivers of this development.

It is not new that human disease is imposing a burden on the sufferers and a challenge for the physician. While neurologists are having the privilege being physicians and have the single patient in our focus of attention, health economists take a different view. Their thinking is focusing on the burden of disease for the society and its economic implications. They look at the costs of disease in different terms. The classical measures for the burden of disease are the costs in terms of disability-adjusted life years (DALYs) which are defined as the sum of years of life lost due to the disease (YLLs) and years lived with the disease (YLDs) accounting for reduced life time with good quality of life due to the disability. Another important measure is the Socio-demographic Index (SDI) reflecting economic and educational development. There is big science behind all these calculations which I will not go into detail here.

Under the leadership of Jes Olesen, Denmark, the European Brain Council (EBC) has developed a ‘cost of brain disease’ project in the last decade, which essentially became one of the most important databases for the development of European Research policy. In 2012 the costs for neurological disease alone were estimated to be 303 billion €/year and the costs for all brain diseases added up to 798 billion €/year, which is about 6 times the budget of the European Union.

The European Academy of Neurology is announcing its third congress from June 24th- June 27th at the RAI Congress Center in Amsterdam. We are expecting more than 6000 neurologists from Europe and all over the world for this outstanding annual event. The programme and the education committee of the EAN worked hard to create a program which will present cutting edge science and first class education for the general neurologist. The purpose is to present excellence in neurology and when the participants leave the congress they will know all about the current status and the important news in our field.

The revision of the International Classification of Diseases (ICD) is a highly complicated process handled by experts in statistics at the WHO in Geneva. The influence of Neurological Societies onto the creation of a revision is through the accredited Societies which are for Neurology and Stroke the World Federation of Neurology (WFN) and the World Stroke Organisation (WSO). They are working within the Topic Advisory Group Neurology (TAGN) and can only make recommendations to the experts. April 2011 the TAGN advised to shift the section “Cerebrovascular diseases” covering all types of stroke from the “Diseases of the circulatory system” class (as it is in ICD-10) into the “Diseases of the nervous system” class (as it proposed in the draft ICD-11). This corresponds to a change of the statistical and legal placement of stroke from Internal Medicine to Neurology. This was then executed accordingly 5 years ago and stroke went under the neurological diseases (08) in the beta-version of the ICD-11. Neurologists all over the world agreed with this decision.

The annual congress is the most important event of our Society. This year European and International Neurologists are invited to attend the third EAN congress in Amsterdam, The Netherlands, June 24-27. Literally hundreds of EAN-members are involved to in the preparation of this congress. I wanted to explain to our members how the congress programme is developed. In its third year of existence of the Society, some of the preparation has come to routine but most of the tasks are highly challenging year after year as one of the aims of the Society is to have new innovations every year.

2 years ago I have already highlighted the work of the European Affairs sub-Committee of the European Academy of Neurology. This is to more closely introduce the partners of EAN at this in Brussels. It is important that our members know about activities of our Society on a European level.

It is unknown which of his many books James Parkinson (1755-1825) has considered the most important one. His 500 pages ‘Medical Admonitions’ for lay people, his ‘Chemical Pocket Book’ covering interesting facts on modern chemistry of the late 18th century, the ‘Hospital Pupil’ on the educational standards of physician education, his collection of minerals and fossils  ‘Organic Remains of a Former World’ or any other of his many contributions. History has clearly shown that his most important contribution was his 1817 ‘Essay on the Shaking Palsy’ which celebrates its 200th birthday this year.

European institutions are sometimes discredited and put into questions. This is particularly true in these times of populistic political movements which try to steer the wheel of European unification backwards. Reasons given by opponents are that ‘European efforts are considered too slow, too burocratic and too inflexible’. ‘There are too many cooks preparing the meal’. Sometimes we hear this also from scientists. The logical conclusion is to spend the money at home in their own countries. The latter view is sometimes even expressed by people who in principle share the European perspective. Populistic politicians go so far to even question the whole EU project. In this respect medical research community can make an argument and a big contribution to the understanding why the EU is important.

EAN pages strives to present one country every month to the readers of the EAN pages. We have seen presentations from Albania, Croatia, Denmark, Estonia, Finland, Georgia, and Ireland so far and I would draw your attention to these wonderful articles in our newsblog. This month we have Latvia and in December it will be Moldovia. The country where the EAN congresses take place (so far Germany and Denmark) are even presented in a series of articles covering special aspects of the development of local neurology. The top neurologists from these countries take their time to present important aspects of their country like Denmark did before the Copenhagen congress in 2016. In a series of seven articles they have presented the state of the art and research in their country concerning basic MS research, pain, dementia, clinical MS research, cerebral blood flow research, clinical neurophysiology and headache. The care structures for patients and how research is helping to develop new treatments and new innovations are outlined and one can learn from their success. Whenever I read their presentations it reminds me to the rich history of neurology in Europe. All the different countries were able to show their particular contribution to the field and the achievements they have reached to provide better patient care.

It is a dream of neurologists to cure degenerative diseases. The big brothers, Alzheimer’s and Parkinson’s disease have always been a huge burden of the population but are now, in the millennium of increasing population age becoming a scourge of humanity. While everybody is acknowledging this, both PD (1) and AD (2) communities of clinician researchers and basic researchers are preparing to attack the problem fundamentally frequently unnoticed by the general neurology community.

It is a dream of neurologists to cure degenerative diseases. The big brothers, Alzheimers’ and Parkinsons’ disease have always been a huge burden of the population but are now, in the millennium of increasing population age becoming a scourge of humanity. While everybody is acknowledging this, both PD1 and AD2 communities of clinician researchers and basic researchers are preparing to attack the problem fundamentally frequently unnoticed by the general neurology community.